PLAB 2 Procedural Skills

Question 1

You are performing venepuncture on a patient. According to best practice, what is the correct order of the procedure?

Accepted Answer

Apply the tourniquet, identify a suitable vein, clean the site with a 2% chlorhexidine swab, allow to dry for 30 seconds, insert the needle bevel up at 15-30 degrees, collect samples in the correct order of draw, remove tourniquet, withdraw needle, apply pressure

Answer

Insert the needle first, then apply the tourniquet

Answer

Apply the tourniquet and immediately insert the needle without cleaning

Answer

Clean the site, insert the needle, then apply the tourniquet

Question 2

You need to perform an arterial blood gas (ABG) sample. Which artery is the first-choice site, and what should you do before attempting the procedure?

Accepted Answer

Radial artery — perform a modified Allen's test to confirm adequate collateral circulation via the ulnar artery before puncturing

Answer

Femoral artery — no preparation needed

Answer

Brachial artery — apply a tourniquet first

Answer

Carotid artery — use ultrasound guidance

Question 3

You are inserting a urinary catheter in a male patient. After inflating the balloon, the patient experiences severe pain. What is the most likely cause and what should you do?

Accepted Answer

The balloon may have been inflated in the urethra rather than the bladder — immediately deflate the balloon, advance the catheter further until urine drains, then re-inflate

Answer

The balloon is in the correct position — the pain is normal

Answer

Remove the catheter completely and abandon the procedure

Answer

Inflate the balloon further to secure it in place

Question 4

You are performing a lumbar puncture. At which vertebral level should you insert the needle, and how do you identify this landmark?

Accepted Answer

At or below the L3/L4 interspace, identified using the intercristal line (a line between the iliac crests crosses the spine at approximately L4)

Answer

Between L1 and L2, identified by counting down from C7

Answer

Between T12 and L1, using the lowest rib as a landmark

Answer

At L5/S1, identified by palpating the sacrum

Question 5

You are suturing a laceration on a patient's forearm. Which suture technique is most appropriate for a simple, clean, linear wound in the emergency department?

Accepted Answer

Simple interrupted sutures — they are versatile, allow drainage, and individual sutures can be removed if infection develops without compromising the entire closure

Answer

Continuous subcuticular suture for all ED lacerations

Answer

Mattress sutures for all superficial wounds

Answer

Staples for all forearm lacerations

Question 6

You are asked to perform a DC cardioversion on a patient with atrial fibrillation and haemodynamic instability. What is the correct energy level and electrode position?

Accepted Answer

Start at 120-150J biphasic (or 200J monophasic) with one electrode below the right clavicle and one in the left mid-axillary line (anterolateral position), ensuring the patient is adequately sedated or anaesthetised

Answer

Start at 50J with paddles placed on the patient's back only

Answer

Start at 360J with paddles on the chest and abdomen

Answer

Start at 10J with paddles on both sides of the neck